title: Single-incision and NOTES cholecystectomy, are there clinical or cosmetic advantages when compared to conventional laparoscopic cholecystectomy? A case-control study comparing single-incision, transvaginal, and conventional laparoscopic technique for cholecystectomy.
abstract: BACKGROUND
  The aim of the present study was to compare the clinical and cosmetic results of transvaginal hybrid cholecystectomy (TVC), single-port cholecystectomy (SPC), and conventional laparoscopic cholecystectomy (CLC). Recently, single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery have been developed as minimally invasive alternatives for CLC. Few comparative studies have been reported.
  
  
  METHODS
  Female patients with symptomatic gallstone disease who were treated in 2011 with SPC, TVC, or CLC were entered into a database. Patients were matched for age, body mass index, and previous abdominal surgery. After the operation all patients received a survey with questions about recovery, cosmesis, and body image.
  
  
  RESULTS
  A total of 90 patients, 30 in each group, were evaluated. Median operative time for CLC was significantly shorter (p < 0.001). There were no major complications. Length of hospital stay, postoperative pain, and postoperative complications were not significantly different. The results for cosmesis and body image after the transvaginal approach were significantly higher. None of the sexually active women observed postoperative dyspareunia.
  
  
  CONCLUSIONS
  Both SPC and TVC are feasible procedures when performed in selected patients. CLC is a faster procedure, but other clinical outcomes and complication rates were similar. SPC, and especially TVC, offer a better cosmetic result. Randomized trials are needed to specify the role of SPC and TVC in the treatment of patients with symptomatic gallstone disease.
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, Postbus 9025, 6710 HN, Ede, The Netherlands, boezem@hotmail.com.
authors.forename: Peter B
authors.initials: PB
authors.lastname: van den Boezem
authors.forename: Simone
authors.initials: S
authors.lastname: Velthuis
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Lourens
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Colin
authors.initials: C
authors.lastname: Sietses
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001828:Body Image; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011795:Surveys and Questionnaires; D014621:Vagina; D055815:Young Adult